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‘The Last Mile’

Dr Nicolette Louissaint, President of Healthcare Ready, spoke exclusively to Hannah Jo Uy of Climate Control Middle East about the organisation’s mission of strengthening healthcare supply chains in areas affected by disasters, educating stakeholders on the importance of thermal stability of medical supplies in crisis situations and about navigating cold stores amidst power constraints and infrastructure damage. Excerpts from the interview, conducted in the context of the savaging Puerto Rico was subjected to in September by Hurricane Maria…

Being the midpoint between the public and the private sector in emergency medical response, what are the main issues of concern when you facilitate operations that require meticulous attention to every part of the supply chain?

In times of crisis, it’s important to ensure critical information is flowing to the right people. For us, what’s interesting about such a position is understanding the responsibility we hold, that it’s not a stop-gap operation, [it’s about making] information move from one person to another or one organisation or another, to make headway in the response.

One of the things we have to continue to understand is our ability to move information and distil and share what the problem is to save lives and impact healthcare. We need to not just move things, but to move things to the right parts [of the supply chain] to affect change. [Critical parts of the] government is important, and so is the private sector for us to do this well.

That’s why we work with the whole supply chain, not just part of it. We work with manufacturers and distributors versus [just] working with pharmacists or going back up to donating medicine. Those are different things, and [our model] requires different groups to come together.

We find that the public wants to work with the private sector and the private sector wants to meet with the public sector, but they just speak a different language.

How important a role do refrigeration and cold storage play in public healthcare, especially with regard to the pivotal work the organisation does in such critical moments?

Refrigeration, cold storage and maintaining a secure cold chain are very important. One of the things we worked on in the last year is making sure patients [are more aware] by providing [them with the right information on] how to keep drugs safe, regardless of disasters. Tracking and moving products typical under the cold chain. Oncology drugs, chronic care conditions, diabetes medicines, and vaccines – we have to think about how we move those. And not just moving them into the port but taking it to the last mile.

We have a lot of partners, and we have a logistics partner – they do move products well and securely. [It’s] critical to have them, because they know how to navigate [the temperatures] in Puerto Rico, so that vaccines go to patients.

One of the other parts we also think of is patient education – on how to make them understand thermal stability. Of course, we wouldn’t use the term, thermal stability, but we make them understand how to protect insulin, how to keep it stable, [and talk about] refrigerators and CDC guidelines.

[It goes] hand in hand with response, immediately everything from thinking about how to move products but also how to help patients understand what to do with products. I’m a scientist by training. I still approach things as a scientist. For me, across the board, we have a long way to go on how we do science education at every level, from how we educate policy-makers to how we get patients to think about thermal stability in practical ways.

As scientists, we have a responsibility to do more in science education; we cannot bury core messages in technical language. There is willingness [among the people to learn]; it is just covered in extremely technical language that adds a barrier; it becomes a lot harder to engage and to get people to jump on its use.

What are your expectations from manufacturers of cold store- or transport refrigeration-related equipment with regard to the unique and specific needs of people in your field? Are these needs being met?

Fortunately, I think we are in an era where a lot of work is being done to track the security of products. We actually took an effort about a year and a half ago, where we looked at supply chain in three different countries, including the United States. We looked at interventions that improved supply chain in disasters, whether in disease outbreaks or natural disasters.

The cool thing is that the technology being used is able to maintain and track the security of products. We are in an era where we have simple technology that could be included in a shipment [to monitor] light sensitivity, temperature, exposure and all that, and tell you automatically whether [the product] is good or not, safe or not.

But as you were touching on, with regard to the handling or equipment, it depends on the crisis. When we see massive loss of power and [we rely on] generator power only, we see equipment that has to be maintained and use other technology to track the integrity of the product, which is very different from other ‘last mile’ cases, where it’s about practitioners and about the handling.

It can be both. [It’s about] using simple technology to track the integrity that has made it easier to use equipment, and training people in crisis situations to deliver medicine safely. [It’s also about training] practitioners on how to get medicine, how to maintain the integrity of the equipment [through] generator power and moving products, to make sure we can deliver it to the people on the ground who need it.

Can you tell us a little bit more about your work in Puerto Rico following Hurricane Maria? How is the organisation working to ensure the integrity of the incoming medical supplies amidst power outages and while battling the high-ambient temperatures in the country?

In some ways, the challenge is more logistical than anything else. We have gotten medicine in both the normal supply chain as well the disaster relief supply chain. We are working with our partner to make sure that the medicine is not only getting to the port but also to the last mile, from moving to the port to the trucks to the clinics and dialysis centres. We are engaging with the right folks.

As you can appreciate, we want to make sure we are not [just] getting medicine, but the right medicine. To get visibility to work with partners to get deliveries of medicine that responds to the need. It’s great to have insulin but [we need] the right amount, not excess; and then, there is not enough antibiotics. It’s really about identifying the need and working clearly on to the island.

Power is still a massive issue; it will be for a while. I think about 95% [of the island] is without power, five per cent power restoration is not much. That means 95% [of the people] is working without power, including critical healthcare, which has to navigate on response and health systems. [There are estimations that it will take] 4-6 months for power restoration. What that means for us is [asking] how we navigate this cold store environment, [which is] constrained in the absence of electrical power.

For cold stores, generator power is being used to try to keep healthcare plugged in and powered. We are making sure and doing our best [for] healthcare facilities to keep those generators running.